RoTaTiOn 2 - POH

Posted by Melanie at Friday, September 02, 2011

For my second rotation, I am in Mott Children's Hospital on the pediatric oncology/hematology (POH) unit with preceptor Dr. Erika Howle.

So far, a typical day involves working up the patients I have been assigned, rounding with the team, and attending boot camp. That's right.... boot camp!

Boot camp is a two week long introduction to oncology that takes place for two hours every afternoon. Tuesday = Pain; Wednesday = Nausea/Vomiting; Thursday = Neutropenic Fever. During these sessions, the P4s on POH are joined by the P4s on Adult Hem/Onc and Gyn/Onc. These sessions are very informative and cover topics that are commonly seen on rotation.

Friday I had a topic discussion with my preceptor about Sickle Cell.

I also have to document notes on my patients in TheraDoc, as well as interventions I have been involved with. For this documentation, I am required to become familiar with the protocol that my patients are receiving, which can be found at http://childrensoncologygroup.org/. It is important to become familiar with the protocols so that you are able to make sure the patient is receiving the correct therapy for that day.

For example, the following is a treatment protocol for Hodgkin Lymphoma:

Drug/Dose/BCCA Administration Guideline
DOXOrubicin/25 mg/m2 on days 1 and 15/ IV push
vinBLAStine/ 6 mg/m2 on days 1 and 15/ IV push
Hydrocortisone/ 100 mg on days 1 and 15/ IV in 50 to 100 mL NS over 10 to 15 min
Bleomycin/ 10 units/m2 on days 1 and 15/IV in 50 mL NS over 15 minutes
Dacarbazine/ 375 mg/m2 on days 1 and 15/ IV in 250 to 500 mL NS or D5W over 1 to 2 hr

The protocol will also indicate which toxicities will likey occur with each drug and when therapy might need to be dose adjusted or omitted. For example:

Hepatotoxicity: DOXOrubicin only
Bilirubin (mmol/L) Dose Modification
2-35 100%
35-85 50%
greater than 85 Omit DOXOrubicin. Substitute cyclophosphamide 375 mg/m2

The protocols will also indicate what supportive therapy should be initiated. For example, antiemetics or PCP prophylaxis.

Overall, this week has been challenging, dealing with three unfamiliar subjects: oncology, hematology, and pediatrics. However, I have learned and great deal and even got to observe a bone marrow biopsy!